Asian and African/Caribbean AQP4-NMOSD patient outcomes according to self-identified race and place of residence.
Journal: Multiple sclerosis and related disorders
Volume: 53
Issue:
Year of Publication: 2021
Affiliated Institutions:
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China. Electronic address: Ltc@ha.org.hk.
Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: herena@ncc.re.kr.
Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates. Electronic address: JacobA@clevelandclinicabudhabi.ae.
Walton Center NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: daniel.whittam@nhs.net.
Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique. Electronic address: emeline.berthelot@chu-martinique.fr.
NeuroCure Clinical Research, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany. Electronic address: friedemann.paul@charite.de.
Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan. Electronic address: nakashima@tohoku-mpu.ac.jp.
Department of Neurology, National Neuroscience Institute, Singapore. Electronic address: janis_sn_tye@nni.com.sg.
Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France. Electronic address: jerome.deseze@chru-strasbourg.fr.
Siriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University,Thailand. Electronic address: jiraporn.jit@mahidol.ac.th.
Department of Neurology, National Neuroscience Institute, Singapore. Electronic address: kevin.tan@singhealth.com.sg.
Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
Walton Center NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: Liene.Elsone@thewaltoncenter.nhs.uk.
Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, United Kingdom. Electronic address: maria.leite@ndcn.ox.ac.uk.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: mmealy@alumni.jh.edu.
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. Electronic address: mlevy@mgh.harvard.edu.
Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany. Electronic address: nadja.siebert@charite.de.
Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Neurology, Slagelse Hospital, Institute of Regional Health Research, Slagelse, Denmark. Electronic address: nasgari@health.sdu.dk.
Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique. Electronic address: pcabre_fr@yahoo.fr.
Siriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University, Thailand; Bumrungrad International Hospital, Thailand.
Departments of Laboratory Medicine and Pathology and Neurology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States. Electronic address: pittock.sean@mayo.edu.
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong. Electronic address: cwh@ha.org.hk.
Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France. Electronic address: thomas.senger@chru-strasbourg.fr.
Department of Pharmacology, Experimental Neuropathology Group, University of Oxford, Mansfield Road OX QT, United Kingdom; Department of Neurology, National Neuroscience Institute, Singapore. Electronic address: tianrong.yeo@some.ox.ac.uk.
Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: y-takai@med.tohoku.ac.jp.
Center for Advanced Neurological Research, Nitte University, Mangalore, India.
Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea. Electronic address: hojinkim@ncc.re.kr.
Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX DU, United Kingdom. Electronic address: jacqueline.palace@ndcn.ox.ac.uk.
Abstract summary
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy characterized by aquaporin-4 antibodies, whose prognosis is influenced by onset age, race, environmental exposures and immunosuppression. Distinguishing the contribution of environment from genetics is challenging. We aimed to compare neuromyelitis optica spectrum disorder (NMOSD) patient outcomes according to self-identified racial group and place of residence.This retrospective analysis of prospectively collected data included non-white anti-aquaporin-4 antibody positive NMOSD patients under follow-up from 15 centers [United Kingdom, France, Germany, Denmark, Martinique, United States of America, Japan, South Korea, Singapore, Thailand, China (including Hong Kong) and India]. Racial groups were designated: African/Caribbean; South Asian; East Asian (including Southeast Asia). Patients from these racial groups residing outside Africa/Caribbean or Asia were compared with those living in the Caribbean or the Asian areas. Kaplan-Meier survival curves and Cox models were generated using time to sustained Expanded Disability Status Scale≥6.0 or death; time to sustained Kurtzke Visual Function Score≥3.0 or a composite endpoint of all three.Among 821 patients, African/Caribbean patients (n = 206) had the shortest time to immunosuppression and higher visual disability at onset. South Asian patients (n = 65) were younger, had lower visual disability at onset and higher mortality rate. East Asians (n = 550) had the lowest relapse rate and lowest accrued motor disability. Survival analysis of African/Caribbean outside Africa/Caribbean vs those in the Caribbean showed a significant difference in the composite endpoint (p = 0.024,log-rank test), not apparently related to treatment differences. No significant differences between native and those residing outside Asia were found for other racial groups.This NMOSD study reports the effects of place of residence on the outcomes in different races. Place of residence may not be a significant driver of disability among Asian patients, while it may influence African/Caribbean patient outcomes. Validating these findings could help distinguish between genetic causes and potentially modifiable environmental factors.
Authors & Co-authors:
Soares-Dos-Reis Ricardo R
Tsz-Ching Jessica Li JL
Kim Su-Hyun SH
Jacob Anu A
Whittam Daniel D
Berthelot Emeline E
Paul Friedemann F
Nakashima Ichiro I
Tye Janis Siew Noi JSN
De Seze Jerôme J
Jitprapaikulsan Jiraporn J
Tan Kevin K
Yang Li L
Elsone Liene L
Leite Maria Isabel MI
Mealy Maureen A MA
Levy Michael M
Fan Moli M
Siebert Nadja N
Asgari Nasrin N
Cabre Philippe P
Siritho Sasitorn S
Pittock Sean J SJ
Wing-Ho Stephen Cheng SC
Senger Thomas T
Yeo Tianrong T
Takai Yoshiki Y
Pandit Lekha L
Kim Ho Jin HJ
Palace Jacqueline J
Study Outcome
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